Prof. Dr. Toygar Toydemir
He received the title of Professor of General Surgery in 2020. Dr. Toydemir, who has extensive experience in reflux and obesity surgery, continues his work in these fields. You can read the rest of our article about Bariatric Surgery prices, treatment process, and post-treatment precautions.
Read More Make an AppointmentBariatric surgery is an effective and long-lasting method for the treatment of severe obesity and related comorbidities. Procedures such as gastric bypass and sleeve gastrectomy can improve both physical and metabolic health. Research shows that this surgery significantly reduces mortality rates in individuals with type 2 diabetes and provides improvements in cognitive functions. However, surgical interventions carry risks, and patient selection requires a comprehensive evaluation and long-term follow-up. Preventing nutritional deficiencies and maintaining lifestyle changes in the postoperative period is critical to treatment success. This process should be managed with the support of a specialized team.
Bariatric surgery has undergone a significant evolution as one of the most innovative fields in modern medicine for treating morbid obesity. The first surgical interventions began in the 1950s when weight loss was observed in patients undergoing bowel resection. These observations led to the development of the jejunoileal bypass (JIB) procedure, which involved bypassing a large portion of the small intestine. However, due to complications such as severe metabolic and liver problems, JIB was not a long-term solution.
In the 1960s, Dr. Edward Mason laid the foundations of modern bariatric surgery by developing the gastric bypass procedure. By creating a small stomach pouch to restrict food intake, Mason’s procedure also regulated intestinal hormones to promote weight loss. This approach proved effective in improving obesity-related diseases, earning Mason the title of “the father of bariatric surgery.”
The 1970s and 1980s saw the development of various restrictive procedures focused on reducing stomach size. During these years, Mason introduced vertical banded gastroplasty (VBG), but low long-term success rates and complications led to its eventual abandonment.
The early 1990s marked a major turning point with the integration of laparoscopic techniques into surgery. The first laparoscopic Roux-en-Y gastric bypass (RYGB) performed by Dr. Alan Wittgrove increased surgical safety and reduced recovery time.
By the 2000s, sleeve gastrectomy (SG) gained popularity. Initially used as a step for more complex surgeries, SG became a standalone procedure over time and is now one of the most commonly performed bariatric surgeries. This procedure is notable for its low complication rates and effective weight loss outcomes.
Throughout its history, bariatric surgery has advanced with continuous innovations to improve patient safety and efficacy, enhancing the quality of life for millions of individuals.
Bariatric surgery is an effective treatment option for individuals struggling with severe obesity who have not achieved sufficient results from other treatment methods. The suitability of this surgical intervention is assessed based on various criteria such as the patient’s Body Mass Index (BMI), comorbidities, age, and psychosocial factors.
BMI Criteria:
Generally, BMI thresholds are determinants for bariatric surgery eligibility. Individuals with a BMI of 35 kg/m² or higher are candidates for surgery even without comorbidities. Surgery may also be considered for those with a BMI of 30–34.9 kg/m² who have metabolic disorders such as type 2 diabetes or hypertension.
Ethnicity and Age Factors:
Ethnic differences may require reevaluation of BMI thresholds. In Asian populations, for instance, individuals with a BMI over 25 kg/m² can be considered obese, and surgery may be recommended for those over 27.5 kg/m². Both younger and older individuals can be surgical candidates; however, risks must be carefully assessed in elderly patients.
Comorbidities and Psychosocial Status:
The presence of obesity-related conditions such as type 2 diabetes, sleep apnea, and hypertension can increase the benefits of surgery. However, the patient’s psychological status, ability to adhere to lifestyle changes, and social support must be evaluated before surgery. Factors such as depression, eating disorders, or inadequate social support can negatively affect surgical outcomes.
Bariatric surgery may not be suitable for every patient. Specific criteria must be considered to ensure that the procedure can be performed successfully and safely. Absolute contraindications refer to situations where surgery cannot be performed under any circumstances. For example, untreated endocrine disorders (like hypothyroidism) may adversely affect surgical outcomes. Likewise, severe cardiopulmonary diseases significantly increase surgical risks. Active gastrointestinal diseases can complicate the recovery process and lead to postoperative complications. Additionally, active substance abuse or uncontrolled psychiatric disorders can impede the patient’s ability to adopt the necessary lifestyle changes after surgery. Pregnancy is also an absolute contraindication.
Relative contraindications require careful consideration. Age factors—those under 18 or over 65—must be evaluated in terms of potential benefits versus risks. Previous abdominal surgeries may complicate the procedure. Nutritional deficiencies must be corrected preoperatively. Additionally, it should be noted that understanding and compliance issues may prevent patients from achieving the desired benefits of surgery. Certain medications, especially long-term use of NSAIDs, can increase the risk of complications.
Finally, habits such as smoking can negatively affect postoperative recovery. Patients are strongly advised to quit smoking before and after the procedure. Fertility planning should be carefully addressed in women, and pregnancy should be deferred until weight stabilization is achieved post-surgery.
Bariatric surgery involves various surgical procedures that alter the anatomy and function of the digestive system to treat severe obesity. Commonly performed methods include Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch (BPD/DS). These procedures support weight loss and improve obesity-related metabolic issues through different mechanisms.
This method restricts food intake and reduces nutrient absorption. A small stomach pouch is created to limit intake. Part of the small intestine is bypassed, reducing absorption. Hormonal changes also enhance satiety and improve blood glucose control. It is usually performed laparoscopically, which increases patient comfort due to its minimally invasive nature.
In this surgery, about 80% of the stomach is removed, leaving a sleeve-shaped stomach. This reduces the ghrelin hormone, controlling appetite and restricting food intake, thus supporting weight loss. Technically simpler than some other procedures, it is also effective in improving obesity-related comorbidities.
A band placed around the upper part of the stomach restricts food intake. This method is less invasive and adjustable, offering certain advantages. However, due to lower weight loss outcomes and the possibility of requiring revision surgery, it is less commonly chosen today.
This method offers the highest weight loss results but is a complex procedure. Due to a high risk of nutrient deficiencies, strict medical follow-up is necessary.
Bariatric surgery is an effective treatment in the fight against severe obesity, but like any surgical intervention, it carries risks of short- and long-term side effects. Short-term complications include bleeding, infection, adverse reactions to anesthesia, and blood clots (deep vein thrombosis or pulmonary embolism). Postoperative pulmonary complications, such as pneumonia or atelectasis, may also occur. Gastrointestinal leaks at surgical connection points can lead to serious infections.
Long-term effects usually relate to nutrition. Absorption of iron, calcium, vitamin B12, and fat-soluble vitamins (A, D, E, K) may be impaired, causing anemia, osteoporosis, or neurological issues. Dumping syndrome, especially after Roux-en-Y gastric bypass, can lead to nausea, diarrhea, and hypoglycemia. Some patients may experience worsening gastroesophageal reflux disease (GERD) after sleeve gastrectomy. Rapid weight loss can increase the risk of gallstones, sometimes necessitating gallbladder removal.
Other long-term risks include bowel obstruction, ulcers, and kidney stones. Psychological effects are also significant; depression, anxiety, or, in rare cases, substance abuse may develop. Women considering pregnancy should note that nutritional deficiencies during the postoperative period can affect fetal development, so it is advised to delay pregnancy for 12–18 months.
Bariatric surgery is an effective and lasting method for treating severe obesity and associated conditions. However, success rates depend on the type of surgery performed, the individual’s adherence to lifestyle changes, and long-term follow-up. Outcomes vary among different surgical techniques.
Roux-en-Y Gastric Bypass (RYGB) stands out for achieving significant long-term weight loss. Studies show an excess weight loss (EWL) rate of about 60% at 10 years. Sleeve gastrectomy (SG), the most commonly performed procedure worldwide, shows a similar EWL rate of 58.3%. While Adjustable Gastric Banding (AGB) is less invasive and reversible, it generally offers more limited weight loss. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) provides the highest EWL rate at around 74.1%.
The benefits of bariatric surgery are not limited to weight loss. It also plays an effective role in improving comorbidities such as type 2 diabetes, hypertension, and cardiovascular disease. For example, the remission rate for diabetes can reach 80%. Bariatric surgery may also reduce the risk of certain types of cancer.
Bariatric surgery requires a careful planning and preparation process. A multidisciplinary approach is essential to enhance surgical safety and optimize outcomes.
First, a medical evaluation is conducted. The patient’s overall health is thoroughly assessed to determine surgical suitability. Cardiovascular, pulmonary, and metabolic systems are evaluated, and any conditions such as heart disease, hypertension, diabetes, or sleep apnea are managed. Laboratory tests and imaging studies are performed during this evaluation.
Nutritional preparation is another critical step before surgery. Patients are generally advised to follow a low-calorie diet prior to the operation, which helps shrink the liver and make surgery safer. Any detected vitamin or mineral deficiencies are corrected, and nutritional counseling aids in adapting to postoperative dietary changes.
A psychological assessment determines whether the patient is mentally and emotionally ready for surgery. Depression, anxiety, or other issues are addressed as needed. Behavioral counseling helps develop healthy habits and control emotional eating.
Lastly, education and lifestyle changes are emphasized. Patients are informed about the surgical process and postoperative expectations.
While bariatric surgery is an effective method for substantial weight loss and overall health improvement, postoperative care is critical to maintain long-term success. This process requires a multidisciplinary approach tailored to the patient’s specific needs.
Postoperative nutrition allows the digestive system to heal and adapt to its new anatomical structure. Initially, patients start with a liquid diet, followed by a full liquid and puréed diet. Solid foods are typically introduced about four weeks after surgery. A protein-rich diet with nutrient-dense foods is crucial. Additionally, to avoid dumping syndrome, high-sugar and high-fat foods should be avoided, and fluids should be consumed separately from meals.
Bariatric surgery can affect the body’s absorption of vitamins and minerals. Therefore, gastric bypass patients must take lifelong multivitamin, iron, calcium, and B12 supplements. Iron supplementation is especially important in women to prevent anemia. Regular lab tests are essential to monitor nutrient levels and adjust supplements as needed.
Regular physical activity helps boost weight loss and supports metabolic health. Patients can begin with light walking soon after surgery and progress to aerobic and strength training. This helps preserve muscle mass and improve overall health.
The weight loss journey can also bring emotional and psychological changes. Support groups or individual counseling can help patients adjust and develop healthy habits.
Regular follow-up visits monitor diet, weight loss, blood values, and overall health. Close supervision by a specialized team is vital to minimize long-term complication risks.
References
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